Creating a New Hypermobility Screening Tool with Aiko Callahan, DPT, and Stephanie Greenspan, DPT

[00:11] Aiko Callahan, DPT: When you look at the very traditional approaches to PT — do 3 sets of 10 of these 5 exercises, every other day — we've all heard some of this in the past. If you just throw someone into that, you have the potential to do more harm than good because you haven't necessarily looked at neuromuscular control. You might be dealing with someone who has limited proprioception, and you're going to see a lot of compensatory patterns that are really common in hypermobility. So if you get someone going on an exercise program and you haven't addressed those issues, you can really run into some trouble, and you can really limit progression.

[01:02] Jennifer Milner: Welcome back to the Bendy Bodies Podcast, where we strive to improve well-being, enhance performance, and optimize career longevity for every bendy body. This is co-host Jennifer Milner here with the Hypermobility MD, Linda Bluestein.

[01:17] Dr. Linda Bluestein: We are so glad you are here to learn tips for living your best bendy life. This information is for educational purposes only and is not a substitute for medical advice.

[01:27] Jennifer Milner: Our guests today are Doctors Aiko Callahan and Stephanie Greenspan, who are both physical therapists who specialize in working with aesthetic athletes and are co-authors, along with Dr. Annie Squires, of Management of Hypermobility in Aesthetic Performing Artists: A Review. So hello and welcome to Bendy Bodies.

[01:46] Stephanie Greenspan, DPT: Thank you for having us.

[01:48] Aiko Callahan, DPT: Hi, thanks for having us.

[01:49] Dr. Linda Bluestein: We're thrilled that you're here.

[01:51] Jennifer Milner: Yes, we are. So before we dive into this article and talk about your findings, could you tell us a bit about yourselves?

[01:59] Stephanie Greenspan, DPT: Sure. I got into performing arts kind of later in life. So I was a physical therapist first before I started dancing — mostly contemporary jazz and hip-hop — and then grew into the circus world when I found you could dance in the air. So I started training as an aerialist and then ended up coaching as well. For a long time, I kept the two worlds separate. I wanted to have my art world and my work world. But then when I got into academia and there was the push to do research, I decided to blend the two worlds and started looking into research specifically in the circus arts — looking at injury surveillance as well as movement.

[02:48] Aiko Callahan, DPT: I think I was a dancer first and then a physical therapist second. And just to echo what Stephanie said, it really is a joy to be able to blend those two things together. So I was in ballet since I was very young and sustained a low back injury when I was in high school, and had an interesting experience with two different physical therapists who treated me very differently. That really piqued my interest in physical therapy. Luckily, I was able to continue doing some dance in college and really focused more on learning different types of dance.
[03:27] But like Stephanie said, those two worlds have usually been sort of separate. Being able to blend those two things in practice is really a lot of fun. I started out with an interest in treating dancers, but then I had physicians starting to refer patients to me for hypermobility. They were like, well, you treat dancers, so you probably understand hypermobility as well. And that's kind of how I got into seeing more people who have hypermobile EDS and hypermobility spectrum disorders — there was this sense of, who's treating hypermobility? As a dance PT, you sort of become the default.
[04:08] By reading into the amazing body of literature that's been expanding around EDS and hypermobility spectrum disorders, I've been able to deepen that knowledge and really come back to see how it might apply to the artistic population.

[04:28] Jennifer Milner: That's great. And as everybody can see, there's no one path to get here. Unfortunately, there's no hypermobility degree that you can go out and get. But so much of our life experience is valuable when we're trying to move forward. We were talking about this before the podcast — being able to take whatever you had to deal with and apply it to help the next generation. So for all of you artists and athletes out there, consider your next career moving forward and helping us with this.
[05:00] So we are going to be talking about a review article that you wrote. First of all, give us a little information on why you wrote the article, and then we're going to dig into what exactly we're talking about here.

[05:13] Stephanie Greenspan, DPT: Sure. Annie and Aiko — Annie's our other co-author — had been seeing a lot of patients with EDS, and we had started having some discussions about doing a research study looking at some physical therapy interventions related to EDS. As part of that process, Annie and Aiko had started looking into the literature and what was out there.
[05:38] Around the same time, I was putting together a special edition on circus arts and trying to collect authors for that, and we needed one more paper. I happened to be listening to the Bendy Bodies Podcast and I was like, well, that would be a great topic. So I reached out to Annie and Aiko and asked, what do you think about writing a review paper using all that literature searching you've done, specific to aesthetic performing artists with a focus on dance and circus? And they were totally game.
[06:12] So we got to work on it and it was really fun. We all deepened our knowledge because we read a lot of papers doing it. We all brought our different backgrounds to it — we all work with a little bit different populations — but looking through all the literature really deepened all of our knowledge around it.

[06:22] Aiko Callahan, DPT: Yeah.

[06:33] Dr. Linda Bluestein: That makes sense. And you had a great table in your article where you talked about some things that were really specific to the aesthetic performing artist that I thought were really helpful, and maybe would be beneficial for our listeners to hear about. For example, when you talk about the artist's identity and participation, habitual postures, and some of those things — would you be able to talk a little bit about that Table 1 that you have in your article?

[07:01] Aiko Callahan, DPT: Certainly. There are a number of specific considerations we have to think about with hypermobile performing artists. Most clinicians who treat performing artists know to ask certain questions about the specifics of a performer's practice — the type of dance, rehearsal hours, performance hours, cross-training, et cetera. But the added layer of hypermobility really does make certain pieces of information even more important to understand, because of how they can affect the recovery of a hypermobile performing artist.
[07:35] A few specific considerations. You mentioned artist identity. That's a question we have to ask the artist: is your identity tied to hypermobility? Is that an integral part of who you are as a performer? Are they wanting to be cast specifically for these more bendy roles? Is that what they're known for? As clinicians, when we look at these movements, we tend to focus on the fact that repetition into extreme range of motion might increase risk of injury. But on the flip side, the artist who sees their range of motion as their primary competitive asset might be worried about missing opportunities if they don't capitalize on that hypermobility.
[08:23] Sometimes it can be really important to have a conversation about the artist's feelings and attitudes about this so that you're on the same page and have the same goals. I remember talking to a physical therapist as a dancer and saying, I need to get my leg up here, and they said, well, just don't do that. And I was like, I think that's the end of this conversation. That's typically how it goes. As a physical therapist, we really want to listen to what that artist's goals are and say, okay, it sounds like you really want to continue to go into extreme ranges of motion — let me see how I can support you in that. Let's talk about pacing strategies. How do we make it so you're not spending too much time in that position? Can we modify that? Understanding how deeply tied to hypermobility an artist is really is important for making sure you're on the same page.
[09:28] Another consideration is the mechanism of onset. With hypermobility — with all these little instabilities you may have going on at different joints — you can see the effects of repetitive microtrauma. Or when you're looking at something like hypermobile EDS, if you're really dealing with connective tissue differences, smaller forces can cause more issues than you would expect. I've had people have one good sneeze and then sublux a rib. You wouldn't expect a sneeze to create so much pain in an individual, but it certainly can when you're dealing with someone who may not have as much stability throughout their joints.
[10:13] In the table, we talk a little bit about types of pain. Typically with musculoskeletal injuries in performing artists, we are thinking of nociceptive pain. But with hypermobility, you may need to keep an eye out for nociplastic pain — formerly called centralized pain. It can be really challenging to know where one stops and the other begins. When you have a conversation that gets more into a description of their pain, someone can have ankle pain with a layer of nociceptive pain but also a layer of nociplastic pain. Then you're asking, what part of your pain changes when you're really fatigued or you haven't had enough sleep? Trying to piece out what is more mechanical and what is more triggered by other stressors that might exacerbate nociplastic pain — getting into that and really understanding the artist's experience is really important.
[11:25] Prior treatment. As a physical therapist treating a dance population, chances are those dancers have had physical therapy before, especially if they've had a number of musculoskeletal injuries. Knowing what's worked in the past and what hasn't is really critical so that you don't waste time as a clinician. Open and honest communication is really important here. When you look at the very traditional approaches to PT — do 3 sets of 10 of these 5 exercises, every other day — if you just throw someone into that, you have the potential to do more harm than good because you haven't necessarily looked at neuromuscular control. You might be dealing with someone who has limited proprioception, and you're going to see a lot of compensatory patterns that are really common in hypermobility. If you get someone going on an exercise program and you haven't addressed those issues, you can really run into some trouble, and you can really limit progression.
[12:26] And then also thinking about a performing artist in the context of performance schedule — I've got to be ready by such and such a date, I need to be doing a certain number of performances by such and such a date — and compound that with the fact that hypermobile dancers or artists with hypermobile EDS may take longer to recover. You really want to prevent the potential for setbacks as much as possible.
You might also want to ask your performing artist how they self-manage. This can be one of the most important areas of education that a clinician can provide, particularly if the patient may not have consistent access to physical therapy — whether they're traveling with a show, there are insurance issues, or transportation issues. Giving them the tools to help manage their own issues is incredibly important. Things like teaching self-mobilization or muscle energy techniques for when things get a little out of whack can be a really important tool. But you have to figure out what they don't know in order to help figure out what tools you can provide.
[13:48] Another thing we tend to look at in physical therapy are habitual postures. It's important to look at how they stand, how they're sleeping, their sitting postures — a lot of these postures that we don't think about so much can really influence muscle balance around a joint and potentially set someone up for injury. We see this even more in hypermobile individuals because they can't rely on the stiffness of their ligaments to maintain optimal joint position. Muscle imbalances — tightness or a particularly overactive muscle — can pull the joint a little bit off-kilter and set people up for pain.
[14:33] Going over habitual postures and seeing how they sit — my favorite with hypermobility is seeing them sitting in a chair where they spiral their legs down around each other. As soon as I see that, I think, aha, hypermobility, here we go. When you point that out, they usually bring their legs up and sit on one hemipelvis. You see a lot of these postural changes, and you figure out that they have their comfortable positions that they like. As you get more into an examination, you'll be able to piece out why they might really like those positions.
[15:16] Another thing we really like to consider is someone's social support system. What is their social environment like? What is their studio like? Do they have a director or a teacher or a coach who encourages them to modify their warm-up? I've talked to dancers who say, oh yeah, my teacher's totally fine if I just stop doing this particular warm-up at the barre and do my own thing for a little bit and then come back. I love hearing stuff like that, because that's such an improvement from a lot of the stories I've heard before. Conversely, is the artist in a situation where they're pressured to go beyond what's safe for their bodies? That can be a really challenging thing, particularly for an adolescent performing artist who is trying to push themselves and trusting the adults around them to consider their safety.
[16:40] Another thing we look at is sleep. Poor sleep is incredibly common in hypermobile EDS and hypermobility spectrum disorders, and that should concern us given that fatigue is a really big risk factor for dance injuries. If you think about the presence of poor rest and how that can set someone up for dance injuries, you can see how those two things might be problematic together.
[17:06] Nutrition. Historically in dance, we see disordered eating and think it's more of a psychological or behavioral issue. But when you go away from the dance injury research and look more at the EDS research, Dr. Carolina Baez de Velasco proposed a different model for disordered eating in hypermobile EDS and hypermobility spectrum disorders. That includes things like abdominal pain or feeling full early, and I believe some sensory issues as well — all these components that could potentially be addressed by a multidisciplinary care team but tend to just get ignored in favor of, well, you're a dancer, so your issue must be psychological and behavioral.
[18:08] I met a dancer who was transitioning out of her dance career and more into academia who had this issue. She said, no one asked me if my stomach hurt when I ate. They just assumed I was anxious, that there were psychological issues contributing to it. She said, no one really listened to me when I said I can't eat that much food — when I do, my stomach gets really full, and if I eat too much, I have a lot of pain. It's very frustrating to hear those stories. What we really hope for is that the model Dr. Baez de Velasco proposed starts to get a little more recognition — perhaps another way of looking at this in our dancers for whom we suspect a connective tissue disorder.
Menstrual history is also a really important thing to look at — does their cycle have an effect on dance and training? While a lot of artists might be aware of bloating and how it might affect how they look or feel, they aren't as aware of how abdominal bloating can inhibit abdominal muscle activation, which in turn can decrease support of the pelvis. When you consider the importance of proximal stability for distal mobility, a stable pelvis is absolutely crucial for leg movement without incurring injury.

[19:41] Jennifer Milner: Yes, that is very true. Those are all really interesting — tools that a lot of us who work a lot with hypermobility sort of instinctively use on our own and have noticed, but maybe haven't codified like that. It's really helpful to hear all of those things listed out at once. I bet a lot of listeners are busy taking notes and rewinding right now.

[20:07] Dr. Linda Bluestein: That was fabulous information about things we should be looking at when we're taking a history — and whether you're a physical therapist, working in mental health, nutrition, or as a physician, anyone who works with this population can really use what you've laid out as an incredible roadmap. You also laid out a roadmap for things we should potentially be doing in a physical exam. I would love to hear you talk about that as well.

[20:37] Aiko Callahan, DPT: Sure. As a physical therapist, when an injured performing artist comes in, we look at things like alignment; movement, both for daily activities and art-specific tasks; motor control — how do they move, what do they use to move, and what movement patterns does that artist use to complete a particular task; range of motion; strength and muscle length around specific joints; and joint mobility. Would you like me to give a more specific scenario to talk through some of this?

[21:19] Dr. Linda Bluestein: You gave some very specific tests — maybe these are things that Jen, when she's assessing somebody, would do automatically, and maybe a lot of physical therapists would know some of these tests. But if you would be willing to go through what you think are the couple of most important ones — we also know that when you're doing dancer screenings, you have limited time, so you have to pick where you'll get the most bang for the buck. Let's say it's not an injured dancer and you just want to get a feel for their joint control and how they're doing with their deep stabilizing muscles. Are there a couple of tests you feel are most valuable in that scenario?

[22:01] Aiko Callahan, DPT: If you're looking for screening, I would divide the tests on this table into categories. The first two — the Stork test and the active straight leg raise to assess pelvic girdle load transfer — are really looking at the stability of the pelvis. We look at these to determine if someone has good proximal stability around the pelvic girdle. The Stork looks at this in a weight-bearing position on your feet, and the active straight leg raise looks at it lying down. The Stork is a little bit more functional because you can see what happens in the pelvis when you transfer your weight onto one foot, as you would for any movement with a gesture leg. You can get a real sense of how well they can weight shift and whether the bones of the pelvis move in the way you'd expect, or whether you start to see some compensatory patterns — if you see them hiking that hip, you know something is going on in terms of the way they move.
[23:11] The active straight leg raise is a test where they're lying down and the patient lifts their leg and lets you know how difficult that is or if it brings on pain. You then essentially squeeze the sides of the pelvis together to create stability through the pelvis, and see whether that alleviates their pain or whether they find it much easier to lift their leg. If providing that force closure of the pelvis manually takes care of some of their pain, you know they might do well with something like an SI belt — or ideally, stability through the musculature. So you might say that person would be appropriate to refer for more core stabilization work. Those two tests are really asking: does this person have a stable pelvis that allows force to be transmitted through it effectively?
[24:17] The test after that is the active straight leg raise for a different purpose, and this is where it gets a little confusing — there are two active straight leg raise tests. One is for the pelvis, which we just talked about, and then there's one that looks at the way the head of the femur moves in the hip. The patient does the same thing in both tests, but what the clinician is looking for is very different. The active straight leg raise to assess anterior femoral glide syndrome is really looking at the stability of the hip joint. It's very common that when you go to lift the leg forward, if the ligamentous structures around the hip don't prevent the femoral head from moving forward, you can end up with a pinching sensation or pain in the hip. As a physical therapist, if someone goes to lift their leg in that manner, what I'm looking for is: does pushing that femoral head back down into the joint so it's a little more centered help to alleviate their pain? So one looks at pelvic stability and one looks at hip joint stability, if that makes sense.
[25:40] I find that test particularly useful in the ballet population because you have a lot of people working in a turned-out position. Every time you tendu back for arabesque, or even just functionally stepping forward, anything that pulls that limb into extension can create excessive anterior shearing of the femoral head in the hip joint. So it's definitely a good thing to look for.
[26:14] The rest of the tests on this table focus more on motor control. The first is the forward step-down test. I tend to use this more in the hypermobile population because I see more deficits in motor control — altered movement patterns. While it isn't strictly a dancer test, I bring it in when I see hypermobility because even your daily movements like going down the stairs can show you interesting things that might cue you into why someone is having issues.
[27:03] Then, from the dance injury literature, there's the airplane test, the single leg sauté test, and the topple test. These are looking at: are you able to control your pelvis and trunk while doing that airplane motion? The body is tipped forward, parallel to the floor, the leg is extended behind you, your arms are out to the side, and you do, I believe, 5 pliés bringing the arms down and together. Can someone maintain control? I really love the airplane test because dancers are so used to being upright and looking in the mirror and getting feedback from the mirror. When they're doing the airplane test and their focus is a little bit more downward, you can piece out some other issues and see what they look like when they may not be getting as much of that visual feedback we tend to rely so much on.
The single leg sauté test is looking more at: can you keep that proximal stability in a jumping situation on a single leg? And the topple test is looking at pirouette en dehors to see whether you have that control. Dance teachers can always pick out when people are having these issues — they're common training issues we see over and over again. From a physical therapy perspective, these tests just give us a clearer picture of where they might be having proximal stability issues as it relates to dance.
[28:37] The last test on here is more specific to artists who use more of their upper extremities — the Closed Kinetic Chain Upper Extremity Test. You're in a plank position, the timer is set for 15 seconds, and you see how many times the individual can tap to reach behind the other hand within that span. The mean for healthy adults is about 13.31 repetitions. That's really important for circus artists, aerialists, hand balancers — you want to be able to see what kind of control and stability they have while doing this. Stephanie, do you have anything to add for that particular test?

[29:30] Stephanie Greenspan, DPT: Yeah. It's a timed test, but you can also look at a lot of motor control while you're doing it and get that information out of it as well. Also, the norms for female-identifying individuals are done with knees on the ground, which I would never ask a circus artist to do. So we need norms in the same position for adults so that it's more standard. That was one I used in my study, so we'll have norms in a circus population to see.

[30:01] Jennifer Milner: Well, several of the tests you mentioned are often used for pre-pointe assessment to make sure a dancer is ready to go on pointe, and so many of these have to do with proximal stability. Artistic athletes are really good at faking that and doing a lot of stability through ankles and knees. If you're a dancer, I imagine there's a whole lot more stability going on in the elbows and wrists than should be for people who do stability on their hands. It's really great to be able to tease that out. And those were some excellent, concrete steps, because it's really hard to codify art — but being able to codify how to treat artists is super helpful. You can say, well, I know you can put your leg behind your head, but are you doing it correctly?

[30:54] Aiko Callahan, DPT: Right.

[30:55] Jennifer Milner: That's cool, but can you do that and also not take your shoulder out of the socket? That's what we want to see. So, I know that you both developed a hypermobility screening tool. Can you tell us a little bit about that?

[31:08] Stephanie Greenspan, DPT: Sure. We're really excited about this tool. It started out as a table, but it was too unwieldy as just a table. It made us think about the fact that we're essentially trying to guide clinicians on a review of systems. The article is geared towards physical therapists, but certainly this tool could be used by any healthcare professional. The idea is, if you have someone who is hypermobile — especially if you suspect EDS — it's important to look for signs and symptoms of other systemic issues. Because there are so many that are possible in EDS, it's a really long list of questions.
[31:51] As we were trying to sort out what to do with all this information, we decided to explore creating a tool that would be a self-report — a checklist that the patient can fill out. There are a lot of benefits to that. One, the clinician doesn't have to remember all that stuff. For clinicians that don't know much about EDS, we want them to be able to screen and refer people out, not just specialists — because the reality is there aren't a lot of people with deep knowledge about EDS out there for people to go to, and that's a big issue. It also saves time. Asking all that information during a visit with limited time could be really time-consuming, but you can give this survey to your patient ahead of time.
[32:53] One other point about doing that ahead of time: we sent it out to a few people we knew to just see what they thought from a patient experience. One thing that came up is that it can be a little re-traumatizing sometimes to think through all these issues in your body. So giving patients time and space to do it at home can be another benefit.
Just to describe the framework of the tool: the first page is a list of signs and symptoms that a patient might experience that are related to disorders in the various body systems, because often these underlying disorders may not have been diagnosed or given a label. That allows us to screen and pick up these things. The second page is the opposite — it's a list of diagnoses they might have received across different body systems that maybe haven't yet been linked as being part of one unifying disorder that's part of EDS. So it gives them two ways to provide information. If you've ever created a survey tool, you know you often have to ask something more than one way to not miss things, and this lets that capture happen from both directions.
[34:15] Once this is filled out, the clinician can take a look at it. Because it's organized by body system on both sides, they can get a sense of how many body systems are involved — do they have checks in all of those categories? They can also get a sense of the extent of involvement: are they checking off all of the symptoms in one category, or is it just one thing? It gives them some big picture perspective.
To provide additional guidance on what to do with this, there's a guide for therapists about identifying, based on the answers, what type of issues the patient might be having and what kind of healthcare professional would be appropriate to have on their team. That's where the clinician can have a conversation with the patient — I see that you're having issues related to, say, dysautonomia, or around eating — and figure out who to send them to. Am I going to send you to a GI doc? A dysautonomia specialist? That sort of thing. It gives clinicians guidance as to what kind of professionals would be appropriate to refer to.
The patient might already have some of those professionals on their team — we hope they do — but if they don't, the clinician can help them build that team. It takes a lot of different people to support these individuals well, and trying to help them build a team empowers the clinician to do that.
[36:03] Our hope is that we start addressing the really common issue that people with EDS are often diagnosed long after they start showing symptoms — that the variety of signs and symptoms they have are brushed off by providers, friends, or family, with the attitude of, why are you always complaining about that stuff? The links aren't made. We're hoping that having a tool like this will help providers who aren't as familiar with EDS to still pick up on the fact that it might be there, and at the very least get people to the proper providers so that they don't get ignored again. Hopefully it'll lead to earlier diagnosis.
[36:53] One thing we're looking at: we created this tool as part of this review paper, but it hasn't been validated. To improve upon it, we are currently looking for funding to do a validation study — bringing in a team of specialists to evaluate the tool, asking whether there's anything we missed that should be on there, whether things should be prioritized, and whether other things should be left off so that we have the best tool possible. Then we'd send it out to populations we know have EDS and populations we know don't, and see how the tool does in distinguishing those populations. So there's work to be done — there might be a new and improved version down the road. But we hope that in the meantime, clinicians will start to use this.
[37:46] It's pretty obvious to a physical therapist when a patient is hypermobile, but in other settings, given the high prevalence of pain, you could think to give this tool out to anyone coming in with pain. Those would be the target populations. And realistically, while we designed it for physical therapists, it could be used by any healthcare provider to do the same screening. There's nothing about the tool that's specific to physical therapy.

[38:15] Jennifer Milner: That sounds amazing, and I would like it in everybody's hands. Is it something that providers can get access to?

[38:26] Stephanie Greenspan, DPT: Yeah, we'll have to figure that out. This is published in a journal that isn't open access. People can email Sharon Klinski, who's the editor, and get a copy for themselves that way, but it's not freely accessible. I'll have to talk to her about the tool specifically — whether there would be a way to extract that. Certainly the people who have access, which is anybody who's a member of the Academy of Orthopedic Physical Therapy and the APTA, is a big group, but it's certainly not everybody who could use it.
[39:05] That's a great question and we'll have to look into it. If we could make it more accessible, it might be something we could put up on an EDS website, or maybe a more mainstream place where people who are just starting to educate themselves about EDS could find it too. Something we'll work on.

[39:23] Jennifer Milner: I know that after this comes out, we are going to be getting messages asking where to get a copy of that tool. So I just had to ask up front.

[39:33] Dr. Linda Bluestein: If we have further updates, we will be sure to include that in the show notes, because this is definitely something I use in my practice. As soon as I saw it — I was very excited to get a little preview quite a while ago, and then I kept asking, is it out yet? — and thank you, by the way, for the acknowledgment in the paper. I was thrilled to get to read it before you published it, because it really was phenomenal. It's a great resource, a great summary, and then you added all these tables and the screening tool.
[40:09] What I love about the screening tool is that you call it a hypermobility screening tool, and it's really not designed to diagnose EDS — it's designed to capture a more complete picture of these people who may be suffering from a lot of different problems where no one is connecting the dots and saying maybe these things are related. I also see patients directly getting access to this, and I hear from a lot of patients that they want to fill it out and take it to their PCP who may know nothing about hypermobility. You did a great job explaining how the tools are to be used, and since it's about 3 pages, I think it's kind of a great standalone. And like you said, it's going to evolve as the validation work happens.

[41:01] Stephanie Greenspan, DPT: Yeah. And realistically, even if you do know a lot about EDS, I use it in my clinical practice — because I had early access — because it saves so much time. Asking about all those systems would take my whole visit. I ask permission because it's also a lot for people to look through and consider. For individuals I might see as part of a screening who aren't having a current problem, I try to approach and say, hey, we have this tool if you're interested in understanding a bit more about your hypermobility or seeing if there's other involvement. Not everyone's ready to go there, and there's definitely some sensitivity about their bodies — especially as a performing artist, opening the door to revealing these other things they're managing. But it's really helpful to get that whole picture even if you do understand EDS. It's not just for people who don't know about it. It gives you that snapshot. We do often have a medical history, but it's not directed and specific to the things we would expect in someone with EDS.

[42:16] Dr. Linda Bluestein: And as you said, by organizing by system, it helps you see whether the problems really lie in just two systems or are truly diffuse.
[42:29] Well, this has been such a great conversation and I feel like I've learned a lot even though I've read this paper multiple times — it's so, so great. And obviously the references you collected — the number of papers you must have read in order to publish this is incredible. Is there anything else we didn't ask you about that you wanted to mention? And also, if you could share more about how we could learn more about the work that you're doing and how to get in touch.

[43:00] Stephanie Greenspan, DPT: Yeah. We really appreciate your podcast and what it's doing to educate people about hypermobility, from clinicians to coaches to people with hypermobility themselves. It's brought so many resources, and I've enjoyed listening to so many experts here.
[43:16] One of our big messages is just that it takes a team, and anything you can do as a coach, as a family member, as a clinician to help build a team to support these artists is really important.
[43:31] As far as contacting me, my website and social media are both under Artletic Science. So instead of "athletic," it's "artletic" — A-R-T-L-E-T-I-C. My website is artleticscience.com, and I'm on Facebook and Instagram as Artletic Science as well. I post about my research, whether I'm recruiting or publishing, and presentations and workshops. Feel free to reach out to me any of those ways.

[44:05] Aiko Callahan, DPT: For myself, I have a LinkedIn profile, so you can reach out to me on LinkedIn, or I can provide my email as well. If you want to reach out, you can email me at [email protected] — I'll spell that out: A-I-K-O-C-A-L-L-A-H-A-N-P-T at gmail.com. I would love to engage and love to hear from your listeners. Thank you again for this opportunity. It's been really nice to have such a great conversation about all of this with you.

[44:45] Stephanie Greenspan, DPT: Definitely. Thank you.

[44:47] Dr. Linda Bluestein: Well, thank you for coming on. We love the work that you're doing, and it's such an important area for research. We just need more data so that we can help our artists and athletes have longer careers — so that they can be walking in their 80s and not dealing with all kinds of problems down the road. We're thrilled that you came and chatted with us.

[45:12] Stephanie Greenspan, DPT: Thank you.

[45:12] Aiko Callahan, DPT: Thank you for having us.

[45:15] Dr. Linda Bluestein: Excellent. You've been listening to Bendy Bodies with the Hypermobility MD, and our guests today were Drs. Aiko Callahan and Stephanie Greenspan, who are both physical therapists who specialize in working with aesthetic athletes. Thank you so much for coming on, and we'll see you next time on the Bendy Bodies Podcast.

[45:32] Jennifer Milner: Absolutely.

[45:34] Aiko Callahan, DPT: Bye-bye.

[45:36] Dr. Linda Bluestein: If you love what you learn, follow the Bendy Bodies Podcast to avoid missing future episodes. Screenshot this episode and tag us in your story so we can connect. Our website is www.bendybodies.org, and follow us on Instagram at bendy_bodies. Leaving a review, following the Bendy Bodies Podcast, and sharing the podcast helps spread the word about hypermobility and associated conditions. This information is not intended to diagnose, treat, cure, or prevent any disease. The information shared is for educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. We'll catch you next time on the Bendy Bodies Podcast.